“They were trying to get us to do the best job we could. We were told that this is very good income for the country,” said a Cuban doctor we’ll call Dr. Jose Suarez, describing instructions from his government as he prepared, five years ago, to leave Cuba for Venezuela. There he was to join up in his nation’s most prestigious, most successful and most lucrative enterprise: its physician-export industry.

Along with his wife and children, Suarez now lives in New York, having defected to the United States in 2009. He asked that his real name and personal details not be used, fearing that family members back on the island would suffer retaliation.

Cuba’s export of medical professionals has gained the Communist country much praise, including most recently from the island’s neighbor and nemesis, the United States, where top officials have praised Cuba’s response to the Ebola crisis in West Africa. The Cuban contingent of medical professionals sent to the epidemic’s hot zone was larger than any other country’s.

Suarez’s story suggests a nuanced picture behind those international accolades, in which these doctors, who bravely combat diseases and treat the poor around the world, are treated as an instrument of the state.

“You have to work where they tell you,” he said. The young doctor was sent to Santiago de Cuba, a 12-hour bus ride away from his hometown at the center of the island. The ride is expensive, and each trip home ate away at his salary, the Cuban equivalent of $20 a month. A year later, he was lucky to be assigned to a hospital near his hometown [...]

Last July the general director of Cuba’s Ministry of Foreign Commerce and Investment, Dagmar González Grau, told Havana’s Popular Assembly that 64,362 Cuban professionals were sent by the state to serve in 91 countries. Three in four of those professionals are in the health sector, González Grau said, according to Trabajadores, a state-run newspaper.

The government, she added, expects those professionals to bring in $8.2 billion in 2014. By those figures, the Cuban government could be earning as much as $6.15 billion from its exportation of doctors alone.

These proceeds far exceed any other Cuban enterprise, with tourism lagging well behind in second place. Sales of Cuban staples like cigars, rum and guayabera shirts are not even close. The sugarcane industry, the pride of the country during the Cold War (though it was heavily subsidized by the Soviet Union), is no longer profitable [...]

According to Gregory Hartl, a WHO spokesman, each doctor working in Western Africa in the fight against Ebola receives from the organization a per diem grant of $200 to $240 a day, depending on the location of service. He said that the money is deposited in a local bank in Africa so that it can be withdrawn by each physician upon presentation of a WHO-supplied approval slip.

A former health professional who still lives in Cuba and asked to remain anonymous said that she recently saw a contract that is typically presented to doctors on their way to the Ebola zone. In it, she said, a doctor is promised $1,500 a month while working in Africa, and an additional $1,500 to be deposited in a Cuban bank account, where it can be withdrawn upon return and evaluation of the work.It is not clear whether that money comes from the per diem from the WHO—and is distributed by Cuban officials who collect it on behalf of the doctors in Africa—or is separate from the WHO money.

Cuban doctors are “sent by their government, so we do not know how that money is distributed,” said a U.N. official familiar with the international efforts in Africa, who spoke on condition of anonymity, as he was not authorized to discuss the matter with the press [...]

Ramona Matos Rodriguez, a Cuban doctor who was sent to Brazil, defected last summer and sued the Cuban government for damages. She said in a deposition that the government presented her with a contract promising a salary of $400 a month, with an additional $600 that would be deposited in a Cuban bank on the island, to be withdrawn by her later.

When she arrived in Brazil, however, Matos Rodrigues discovered that Brasilia pays an average of $4,200 a month for each of the 11,000 Cuban doctors working in Brazil. That arrangement leaves most of the money Brazil allocates for the doctors in the hands of the Cuban government.

And this month Brazil’s federal prosecutor Luciana Loureiro Oliveira said that paying Cuban doctors a mere quarter of what the Cuban government collects for them is “downright illegal” under Brazilian law.